Hernia (ER Story)

One-month-old Connor
has a hernia… a tear or hole in his abdominal muscle.

His parents took him to the emergency room at Children’s
Healthcare of Atlanta. Dr. Lonnie King says, “He had a little
portion of his small bowel that had slipped into that hole and
had gotten trapped.”

Connor has been vomitting for two days. Dr. King tells Connor’s
parents, “I think this is mechanical. You know a blockage
in his bowels. That would explain him vomiting, vomiting the green
stuff, and also having a lot of gas that’s trapped in there
because stuff is not moving on through.”

Most likely, the hernia is causing all of Connor’s
problems. But doctors also must check for something else–
a twisted bowel.

Connor drinks a liquid visible on x-rays. Normally, the liquid
should form the letter “C” when it gets to the bowel.
It does. That means his bowel is not twisted.

Connor’s only problem is the hernia… but doctors
worry it will swell. Dr. King says, “Then it starts cutting
off the blood supply of the bowel, and it becomes an emergency.”

Without blood, that part of the bowel can die. That’s why
Connor needs surgery now. His parents kiss him good-bye. Then Connor
heads to the operating room.

The surgeons make a small incision, push the bowel back into
place, and then sew up the hole in his muscle tissue. Dr. King
says, “Connor was fixed, and this was a permanent fix. It’s
unusual for him to have any problems in the future.”

Doctors say check with your pediatrician immediately if your baby
has a swelling in the groin that doesn’t go away. It could
be a hernia. Another warning sign? Green or yellow vomit in a baby
under two-months-old.

A hernia occurs when a section of intestine slips through a weakness
in the abdominal muscles. A hernia that occurs in the groin region is called
an inguinal hernia.

According to the Lucille Packard Children’s Hospital, inguinal
hernias occur:

• In about one to three percent of all children.
• In boys much more frequently than in girls.
• More often in the right groin area than the left.

Inguinal hernias appear as a bulge or swelling in the groin or scrotum.
The swelling is usually non-tender, and the bulge may be more noticeable
when the baby cries. Most inguinal hernias can be gently pushed back
into the abdomen by a doctor; however, some will require surgery.

If the bulge is unable to be coaxed back into the abdomen,
it is possible that the loop of the intestine that protrudes into the muscle
may become stuck. The blood supply to that part of the intestine can become
cut off, causing severe damage to that part of the intestine. This is a
serious condition and requires immediate medical attention.

Symptoms may include:

• Vomiting
• A full, round abdomen
• Pain or fussiness
• Redness or discoloration
• Fever

An operation is necessary to repair the hernia. The Canadian Association
of Paediatric Surgeons (CAPS) says that surgical repair in babies
under 6 to 12 months of age should be carried out as soon as convenient
after diagnosis because they are at higher risk of having the bowel
become stuck in the hernia.

During the operation the loop of intestine is placed back into the
abdominal cavity. The abdominal muscles are then stitched together.
Sometimes a piece of meshed material is used to help strengthen the
area where the muscles are repaired.

Once the hernia has been surgically repaired, it is unlikely to return.
Less than 1 percent of surgically repaired inguinal hernias reoccur,
according to CAPS. Reoccurrence is slightly more frequent in cases
where damage has occurred to the intestine before surgery.